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BONE
Types of bones
1. Long – Thigh, leg, arm, forearm
2. Short – bones of ankle and wrist
3. Flat – most bones of cranium, ribs
4. Irregular – vertebrae and some bones of skull
An adult human skeleton - 206 bones in total. The total bones of our
body can be divided into axial skeleton (80) and appendicular skeleton
(126).
Cranial bones 1. Ethmoid (1)
2. Frontal (1)
3. Occipital (1)
4. Parietal (2)
5. Sphenoid (1)
6. Temporal (2)
Sutures1. Coronal suture – frontal bone with right and left parietal bones
2. Sagittal suture – two parietal bones
3. Lambdoid suture – occipital bone with right and left parietal bone
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Facial bones –
1. inferior nasal concha (2)
2. lacrimal bones (2)
3. mandible
4. maxilla (2)
5. nasal bones (2)
6. palatine bones (2)
7. vomer
8. zygomatic bones, or zygoma (2)
Sinus –
1. The frontal sinuses – frontal bone, behind superciliary arches –
highest
2. The ethmoid sinuses – lies in ethmoid labyrinth – anterior, middle
and posterior group of air cells
3. The sphenoid sinuses – in the body of sphenoid bone behind upper
part of the nasal cavity, extend backwards under the sella turcia
4. The maxillary sinuses (maxillary antra) – largest of the paranasal
sinuses – pyramidal-shaped spaces in the in the body of each maxilla
Carpal bones – 8 bones
lunate, triquetrum, pisiform, hamate, capitate, scaphoid, trapezoid and
trapezium
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Tarsal bones – 7 bones
calcaneus, talus, navicular, medial, intermediate and lateral cuneiform and
cuboid
Vertebrae - 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal
Pelvis - pubis, ischium, and ilium bones
Shoulder – humerus, scapula and clavicle
Ribs - The three types of ribs are the vertebrosternal or true ribs(1 to 7),
vertebrochondral or false ribs (8 to 10), and the vertebral or floating ribs
(11&12).
What are the different types of joints?
1.
Fibrous joints – sutures
2.
Cartilaginous joints – symphyses
3.
Synovial joints
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Synovial Joints
1.
Hinge joints – elbow, interphalangeal joints
2.
Condylar joints – knee joints
3.
Ellipsoid joints – wrist joint and metacarpophalangeal joints
4.
Saddle joints – carpometacarpal joint of thumb
5.
Pivot joints – superior and inferior radioulnar joints
6.
Ball and socket joints – hip and shoulder joints
7.
Plane joints – vertebrae
Systems
1.
Integumentary System - skin
2.
Skeletal System – bones, ligaments, cartilage and joints
3.
Muscular System – muscle fibers
4.
Nervous System – brain and spinal cord
5.
Endocrine System – glands and organs
6.
Cardiovascular System – heart and vessels
7.
Lymphatic System - lymph
8.
Respiratory System – lungs, trachea
9.
Digestive System – oesophagus, stomach, small intestine and large
intestine
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10. Urinary System - kidneys, ureters and bladder
11. Reproductive System
Nervous system
1. Central nervous system – brain and spinal cord
2. Peripheral nervous system - nerves that branch off from the spinal
cord and extend to all parts of the body
Brain – cerebrum, cerebellum, midbrain, pons and medulla oblongata
Spinal cord - cervical 8, thoracic 12, lumbar 5, sacral 5, and coccygeal 1
Cardiovascular system
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Heart – right and left ventricles, right and left atria (ဘယ်-သန/် ညာ- ညစ်)
The Pulmonary Circulation
1. Main pulmonary artery – right and left pulmonary arteries
2. Pulmonary veins – upper right pulmonary vein, lower right
pulmonary vein, upper left pulmonary vein and lower left pulmonary
vein
The Systemic Circulation
The branches aorta
 The ascending aorta – right coronary artery, left coronary artery
 The arch of aorta – innominate artery, left common carotid artery, left
subclavian artery
 The descending aorta – intercostal arteries (9 on each side)
 The abdominal aorta –
o inferior phrenic arteries - diaphragm
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o coeliac axis - hepatic artery_ liver, left gastric artery _ cardiac end
of stomach,
o splenic artery - spleen, stomach and pancreas
o superior mesenteric artery – whole of small intestine, apart from
upper part of the duodenum and the large bowel around to the
distal 3rd of the transverse colon
o right and left suprarenal arteries – right and left suprarenal glands
o right and left renal arteries – right and left kidneys
o testicular arteries (ovarian arteries in female) – testes (ovaries)
o inferior mesenteric artery – large bowel from distal 3rd of
transverse colon, the descending colon, the sigmoid colon and
the rectum
o lumbar arteries – muscle of the back and the anterior abdominal
walls
o common iliac arteries – internal iliac artery (reproductive organs,
the bladder, the anus, the muscle of the pelvic floor, the muscles
of the gluteal region and the hamstring muscles) and external
iliac artery –→ femoral artery –→ popliteal artery - → anterior
tibial artery & posterior tibial artery
Arteries of head and neck
 right common carotid arteries (↑innominate artery) and left
common carotid artery (↑arch of aorta)
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 external carotid artery – superficial tissues of the head and neck
o superior thyroid artery
o ascending pharyngeal artery – pharynx and part of middle ear
o lingual artery – tongue and structures of the floor of the mouth
o facial artery – face
o occipital artery – posterior part of scalp
o posterior auricular artery – side of the scalp and ear
o superficial temporal artery – upper part of the face and side of
the scalp
o maxillary artery –
 internal carotid artery - a large part of cerebral hemispheres, eyes and
its associated structures, skin of forehead and the anterior part of the
scalp
o ophthalmic artery
o anterior cerebral artery – anterior and middle parts of the cerebral
hemisphere
o middle cerebral artery – a large part of the cerebral hemisphere
 left and right vertebral arteries - spine, cerebellum and the medulla
oblongata – (+) →basilar artery – cerebellum and midbrain →two
posterior cerebral arteries – temporal and occipital lobes of the
cerebral hemisphere
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9 regions of Abdomen
1.
right hypochondriac - right portion of the liver, the gallbladder, the
right kidney, and parts of the small intestine.
2.
left hypochondriac - part of the spleen, the left kidney, part of the
stomach, the pancreas, and parts of the colon.
3.
right lumbar - the gallbladder, the right kidney, part of the liver,
and the ascending colon.
4.
left lumbar - the descending colon, the left kidney, and part of the
spleen.
5.
right iliac - the appendix, cecum, and the right iliac fossa.
6.
left iliac - part of the descending colon, the sigmoid colon, and the
left illiac fossa
7.
epigastric - the majority of the stomach, part of the liver, part of
the pancreas, part of the duodenum, part of the spleen, and the
adrenal glands.
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8.
Umbilical - the umbilicus (navel), and many parts of the small
intestine, such as part of the duodenum, the jejunum, the ileum and
the transverse colon
9.
hypogastric (or pubic) - bladder, part of the sigmoid colon, the
anus, and many organs of the reproductive system, such as the
uterus and ovaries in females and the prostate in males.
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Digestive System
Gastrointestinal (GI) tract (Alimentary canal) – about 30feet in
length
1. the mouth
2. the pharynx
3. the oesophagus
4. thre stomach – fundus, body, and the pyloric antrum
5. the small intestine – duodenum(30 cm), jejunum(110 cm) and
ileum(150 cm)
6. the large intestine – the caecum, the colon ( ascending(25 cm),
tranverse(65 cm), descending (30 cm) and sigmoid(55 cm) ) and the
rectum(15 cm)
The Salivary glands – parotid glands, submandibular glands and
sublingual glands
The pancreas
1. pancraetic juice
2. group of cells called Islets of Langerhans – secretes hormone insulin
The liver – wedge shaped – largest gland – right, left, quadrate and
caudate lobes
The gall bladder – cyctic duct - bile
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Billary tree – left and right hepatic ducts – common hepatic duct(3cm)
+ cyctic duct(gall bladder) – common bile duct(7.5cm)(passes behind
the head of pancreas) – finally unite with the pascreatic duct – enter
the second part of duodenum
Respiratory System
Respiratory tract
1. the nose
2. the pharynx
3. the larynx – 3rd to 6th cervical vertebra
4. the trachea – 10cm long – 6th cervical to upper border of 5th thoracic
vertebra
5. the bronchi – right (2.5cm) bronchus enter the right lung at 5th
thoracic and left (5cm) bronchus enter the left lung at 6th thoracic
vertebra – behind the arch of aorta and in front of the oesophagus
and descending aorta
6. the lungs
Right lung – upper, middle and lower lobes
Left lung – upper and lower lobes
Hila of the lungs 1. the bronchus
2. the pulmonary artery
3. the two pulmonary veins
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4. the bronchial arteries
5. the lymphatic vessels
6. nerves
Urinary system
Urinary tract
1. The kidneys – horse shoe shape, left kidney higher than right
2. The ureter
3. The urinary bladder
4. The urethra – male urethra shares with the reproductive system,
female is about 4cm
Endocrine system
The glands of endocrine system – ductless glands – secrete directly into
blood stream
1. The pituitary gland - in brain
2. The thyroid gland – in neck
3. The parathyroid gland – above thyroid
4. The islet of Langerhans - the pancreas
5. The adrenal glands – above kidney
6. The testes - male
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7. The ovaries - female
8. The pineal gland – in brain
9. The thymus gland – in upper chest behind sternum
Reproductive system
Male reproductive organs
1. Two testes and two epididymis which lies in the scrotum
2. Two seminal ducts
3. Two seminal vesicles
4. Two ejaculatory ducts
5. The prostate gland
6. The penis (male urethra)
Female reproductive organs
1. The internal organs – 2ovaries, 2uterine (fallopian) tube, the uterus
and the vagina
2. The external organs – the vulva and the female breast
Contrast Media
Two types of contrast-
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1. Negative – air, O2, CO2
- GUD
- Intestinal obstruction
- Cystic formation
- Paranasal sinuses
- Surgical emphysema
2. Positive
Positive contrast – water soluble & water insoluble
Water soluble – iodinated contrast media( Iopamidol, Iohexol )
Water insoluble – barium sulphate
Reactions due to iodine contrast media
1. Mild reactions
- Sensation of warmth (န ွေးခနဲဖြစ်)
- Nausea (မွေး)
- Faintness (နြ ာ)
- Sneezing ( ာနခ )
- Coughing (နခ ာင်ွေးဆွေး)
- Vomiting (အန်)
2. Severe reactions
- Shock/rigor
- Angioneurotic edema
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- Bronchospasm
- Circulatory collapse
- Respiratory arrest
- Cardiac arrest
Central Rays & Patient Positioning
CXR – midsagittal plane at 7th thoracic vertebra
KUB – the level of iliac crests
Plain X-ray – 2 inches above iliac crests
Hand PA& oblique – third MCP joint
Forearm AP & Lat – midforearm
Elbow AP& Lat – mid elbow joint
Humerus AP – midpoint of humerus
Shoulder AP – 1inch inferior to coracoid process
Foot AP & oblique – base of third metatarsal
Foot Lateral – medial cuneiform (at the level of base of 3rd metatarsal)
Calcaneus Axial – base of 3rd metatarsal & angle CR 40 degree cephalad
from long axis of foot
Calcaneus Lateral – perpendicular to IR, 1inch anterior to medial malleolus
Ankle Ap – midway between malleoli
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Ankle Lateral – directed to medial malleolus
Leg AP & Lateral – midpoint of leg
Knee AP – Align CR parallel to articular facets, half inch distal to apex of
patella
Knee Lateral – half inch distal to medial epicondyle
Femur AP & Lateral – midpoint of femur
Pelvis AP – midway between level of ASISs and the symphysis, 2inches
inferior to level of ASIS
Pelvis outlet – angle CR cephalad 20° to 35° for males and 30° to 45° for
female, a middle line point 1 to 2inches distal to the superior border of
the symphysis pubic or greater trochanters
Pelvis Inlet – angle CR caudad 40°, direct CR to a midline point at level of
ASISs
Cervical Spine AP – Angle CR 15° to 25° cephalad, to enter at the level of
the lower margin of thyroid cartilage to pass through C4.
Cervical Lateral – CR perpendicular to IR, directed horizontally to C4
Thoracic (Dorsal) spine AP & lateral – CR center to T7, 3to4 inches below
jugular notch or 1to2inches below sternal angle
Lumber Spine AP & Lateral – center to level of L3 (lower costal margin,
1.5inches above iliac crest)
Sacrum AP Axial – angle CR 15° caudad, 2inches superior to symphysis
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Sacrum Lateral – CR perpendicular to 3to4 inches posterior to
ASIS(sacrum)
Skull
AP axial (Towne) – Angle CR 30° Caudad to OML or 37° caudad to IOML,
center at mid sagittal plane 2.5 inches above the glabella to pass through
the foramen magnum at the level of the base of the occiput
Lateral – perpendicular to IR, center to a point 2inches superior to EAM
or halfway between the glabella and inion for the other types of skull
morphologies
PA axial (Caldwell) – angle CR 15° caudad and canter to exit at nasion
PA(0°CR) – glabella
Sinus
Lateral – center to zygoma, midway between outer canthus and EAM
Waters (tripod & LeFort fracture) – MML perpendicular to IR, center to
exit at acanthion
Modified Waters (Blowout fracture) – LMP perpendicular, OML forms 55°
angle with IR, CR center to exit at acanthion
Nasal lateral – ½ inch inferior to nasion
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Discovery Of X-ray
-Wilhelm Conrad Roentgen (German Physicist)
-8th November,1895
-Institute of Physics, Wurzburg University
-Won novel prize at 1901
X-ray (Roentgen Ray)
This ray way previously unknown and he named the radiation “Xray”. X stands for unknown quantity.
Bremsstrahlung (Bremsen- to break, Struhlung- radiation)
Nature And Properties of X-rays
Nature
1. Electromagnetic wave
2. Invisible
3. Extremely short wavelength (E α 1/λ), short wavelength – high energy
4. Travels in straight line
5. Travels at the speed of light (c=3 x 10⁸m/s)
Properties
1. Penetration
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2. Photographic effect
3. Chemical effect
4. Ionizing
5. Fluorescence
6. Biological effect
Exposure components – kVp, mAs, time (s)
kVp (kilovoltage peak) – the power and strength of the x-ray beam (quality
of x-ray)
mAs – the number of x-ray photons produced by the x-ray tube at the
setting selected (quantity of x-ray)
time(s) – exposure last
Radiation
Radiation is the energy that can travel space or matter. Two types
of radiation used in diagnostic imaging are –
1. Electromagnetic radiation
2. Particulate radiation
Electromagnetic Radiation (EM)
- no mass, is unaffected by either electrical or magnetic field
- constant speed in a given medium.
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- travel in straight line; however, its trajectory can be altered by
interaction with matter. This interaction can occur either by absorption
(removal of radiation) or scattering (change in trajectory). Visible light,
radio-waves and x-ray are different types of electromagnetic radiations
Particulate Radiation
- fast-moving subatomic particles or a particle beam if the particles are
all moving in the same direction, similar to light beam.
- wave character
Particles
Symbol
Relative Charge
Mass(amu)
Alpha
α
+2
4.0028
Proton
p
+1
1.007593
Electron (βˉ)
e¯
-1
0.000548
Positron (β)
e⁺
+1
0.000548
Neutron
n°
0
1.008982
Characteristics X-ray
- discrete wavelength which are the characteristics of the emitting
element
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Bremsstrahlung X-ray
- the spectrum in which is continuous, arising from the retardation of
moving charged particles is called Bremsstrahlung x-ray.
Source of X-ray
1. Natural sources – sun, radioactive materials
2. Artificial sources – X-ray tube, atomic bomb, nuclear reaction
Interaction of Electrons with the Target material
When the accelerated electron arrives at the target, it is interacts
in four ways;
1. Excitation in an outer shell
2. Ionization in an outer shell
3. Ionization in an inner shell (characteristic x-ray)
4. Interaction with nuclear field (bremsstrahlung)
X-ray interacts with matter in four basic ways;
1. Coherent/classical/elastic/unmodified/Rayleigh or Thompson scattering
2. Compton
effect
or
Compton/incoherent/modified
or
inelastic
scattering (much greater energy than orbital electron)
3. Photoelectric effect/absorption (complete absorption of photon)
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4. Pair production/formation (1.02 MeV)
Collimation
Collimation is the process of restricting and confining an x-ray beam
to a given area.
Benefits
 Reduction in patient dose and staff dose
 Improvement of image contrast due to a reduction in scattered
radiation.
Filtration
When the intensity of the beam is selectively reduced by the
absorption of a particular of its wavelength, this process is called filtration.
Benefits
 Beam energy becomes homogenous and increase penetration
power, called beam hardening
 Removal of low energy photons and radiation dose is reduced (skin
dose)
Disadvantages
 Beam intensity is reduced
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 Emission of characteristic x-ray from filter may occur unnecessarily.
Two types of filtrations (total filtration)
 Inherent filtration
 Added filtration
Inherent filtration
1. Target inserts
2. Glass envelope
3. Insulating oil
4. Tube port
It may be usually 0.5mm to 1.1mm aluminum equivalent.
Different forms of added filters
1. Commonly aluminium (Al 13)
2. Higher atomic number than aluminium metal for x-ray beam
generated about 120kVp
3. Copper (Cu 29) for up to 200kVp
4. Tin (Sn 50) for 200 to 400kVp
5. Lead (Pb 82) for 800kVp to 2Mev
Grid
 Reduce the amount of scattered radiation that reaches the IR
 Produce the short scale contrast (improve contrast)
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 Place between the patient and the IR
 Use when the body parts to be examined is above 10cm
Types of grids
1. Stationary grid
2. Moving grid
- Reciprocal grid
- Oscillating grid
Factors controlling quality and quantity of x-ray beam
Controlling factors
Beam quantity
Beam quality
Exposure time(s)
Iαs
No effect
Tube current(mA)
I α mA
No effect
Tube voltage(kVp)
I α kV
kV α hυ
Filtration
I α 1/filtration
Becomes relatively homogeneous
Atomic number(Z)
IαZ
No effect
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Common Tube Faults
Symptoms
1
Possible faults
Filament failure
-No
mA/mAs
reading
during exposure and film
found to be unexposed
-Finally
contact
in Long useful life of
filament
circuit
or the
filament breakage
-Loose
-Unstable
region
of
mA/mAs
between
zero
Causes
contact
tube
and
careless handling
in
filament circuit
and unexpected value
2 Anode rotor ball-bearing Wear and tear in ball Unnecessarily
deterioration
-increased
races
noise
long
running
while
running
3 Anode damage
-pitting (roughening) -repeated
-gradual reduction in x-
of target surface
overloading
ray output
4 Anode wobbling
Anode
-apparent movement of
light
patch
fluoroscopic screen
on
stand
been bent
has Excessive
heat
conduction
thru
anode stand during
long
exposure
continuous
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5 Tungsten vaporization
-deposition
-change in colour of glass
wall
and
increased
modification
of
beam
vaporized
of Long useful life of
tungsten the tube
on inner surface of
glass wall
quality and quantity
6 Loss
of
vacuum Occulated
(gassiness)
released
-unstable
reading
of
mA/mAs,
shooting
to
gas Repeated
from
high
the loading
components of the
tube
value of unexpected
7
Glass puncture
-oil entering the tube
observed thru aperture
Glass-wall has been Careless
punctured
rough
handling, formation
of air bubbles in oil,
the long useful life of
tube
Total Radiation
a. Primary radiation
b. Scattered radiation
c. Exit radiation
d. Remnant radiation
e. Leakage radiation
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f. Back scattered radiation
Scattered radiation
 Change in direction of primary radiation
 Patient is main source of scattered radiation (round about 90%)
 Image contrast decrease
 Increase radiation dose to operator
Minimization to scattered radiation
To the patient
 Acceptable use of low kVp
 Beam limitation (coning/collimation)
 Volume reduction
To IR
 Use of air gap technique
 Anti-scattered grip
Measure of Quantity of Radiation
1. Absorbed dose – amount of energy imparted by radiation to an
irradiated medium per unit mass. (1Gy=1J/kg)
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2. Equivalent dose – absorbed dose in a given type of tissue weighted by
a factor to take account of the effectiveness of the type of radiation
(express in sievert (Sv))
3. Effective dose – the sum total of equivalent dose each weighted by a
tissue weighting factor to take account of the radiosensitivity of the
organs or tissue being exposed. (Express in sievert (Sv))
4. Committed dose – the total dose delivered to tissue during the period
of time the radionuclides remain in the body. (Express in roentgen
equivalent man (rem) or sievert (Sv))
SI
Radioactivity
becquerel (Bq)
CGS
curie (Ci)
Radiation
Absorbed Dose
gray (Gy)
absorbed dose
(rad)
Equivalent Dose/
Committed Dose
Exposure
Roentgen
sievert (Sv)
equivalent man
(rem)
coulomb/kilogram
(C/kg)
roentgen (R)
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Radiation Dose Limit
- An effective dose of 20mSv per year average over consecutive year
for whole body
- An effective dose of 50mSv in any single year for extremities
- An effective dose of 4mSv shouldn’t exceed during the gestation
period for declared pregnant mother.
Radiation Dose Limit (Public)
- An effective dose of 1mSv in a year
Early effects
 Associated with relatively high dose received in a short period of
time (eg. Radiation accident, blast of atomic bomb) may be
categorized as hemopoietic syndrome, gastrointestinal syndrome,
cardiovascular syndrome and acute radiation syndrome.
 A few gray (0.7 to 10Gy) to bone marrow → inactivation of stem
cells
 Several gray to epithelial cells → diarrhea, hemorrhage of internal
lining, electrolyte imbalance, dehydration, etc.)
 >50Gy → neurologic (brain and neuronal damage) and destruction
of blood vessels in CVS components
 >100Gy → death in a few days (may be in hours)
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Bioeffects as classified in Radiation Protection
1. Deterministic effects
- Those effects for which the severity of the effect increases with dose
above a certain threshold level
- Certain to occur if the dose received by a individual exceed the threshold
level
effect
Threshold dose (Gy)
epilation
5
Skin-damage
14-15(repairable) & 60 (irreparable)
Sterility (female)
0.65/2.5 (T/P)
(male)
0.15/3.5 (T/P)
2. Stochastic effects
- Those effects for which the probability of the effect occurring rather than
its severity increases with dose above natural incidence level
- Appear to have no threshold dose level
- Cannot be related to any particular exposed individual
- Only statically detectable in a population
- Carcinogenesis of intension of cancer
- Teratogenesis of intension of birth defect by irradiation of fetus utero
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- Mutagenesis of intension of genetic disorder in future generation by
irradiation of gem cell.
Personal Monitoring Dosimeters
1. Film badge
2. Thermoluminescence dosimeter (TLD)
3. Optically stimulated luminescence dosimeter (OSLD)
4. Electronic dosimeter